Saturday, April 02, 2016

And by most projections, it’s only going to get worse — the U.S. could lose as many as 1 million doctors by 2025, according to a Association of American Medical Colleges report.

Primary-care physicians will account for as much as one-third of that shortage, meaning the doctor you likely interact with most often is also becoming much more difficult to see.

Tasked with checkups and referring more complicated health problems to specialists, these doctors have the most consistent contact with a patient. But 65 million people live in what’s “essentially a primary-care desert,” said Phil Miller of the physician search firm Merritt Hawkins.

Without those doctors, our medical system is “putting out forest fires — just treating the patients when they get really sick,” said Dr. Richard Olds, the chief executive officer of the Caribbean medical school St. George’s University, who is attempting to use his institution’s resources to help alleviate the shortage.

Dr. Ramanathan Raju, CEO of public hospital system NYC Health + Hospitals, goes even further, saying the U.S. lacks a basic primary-care system. “I think we really killed primary care in this country,” said Raju. “It needs to be addressed yesterday.”

Interesting. 65 million people lack primary care. There are at least 61 million post-1965 immigrants. One way to assure that all Americans have sufficient health care is to repatriate those 61 million people. Wouldn't having primary medical care be considered in the American national interest?

But I don't see what the problem is. Have we not been repeatedly assured that those 61 million immigrants are here to do the jobs that Americans won't do? I'm sure Dr. Dirka, Dr. Jose, Dr. Wang, and Dr. Awolowo will do a bang-up job, despite their lower average IQ, under the guidance of Dr. Raju.

The connection may seem a little strange to you, but just as the changing ethnic demographics significantly altered the behavior of Wall Street bankers, I suspect that they have also changed the specialties pursued by med school graduates.

The most likely solution is to relax the accrediting standards for med schools, which should have been done back in the 1980s.

They've had programs for years that pay for part or all of med school if the student agrees to a certain number of years of service in the rural under served areas. Apparently not a lot are interested in that option.

My employer has a son who is a physician. There's a few rules-of-thumb to running a medical clinic. One is "Don't have to many Medicaid patients or you'll go broke," The reason is Medicaid's payments are set & often don't even cover the cost of supplies used in procedures, leaving the overhead & wages as a loss. The threshold percentage of patients that will break a Climic is in the teens. The reason a small subset of patients can do so much economic damage? They go to the doctor often because it's free for them.

While they have not eased accreditation, my guess is they have changed it from being medical to being political by association. If you aren't a liberal, it doesn't matter how well you understand or what you know. Doctors have become more liberal, but worse and worse for that even beyond the obvious. Being liberal, they mistreat, misdiagnose, and worse those of a different political persuasion.

VD:I'm sure Dr. Dirka, Dr. Jose, Dr. Wang, and Dr. Awolowo will do a bang-up job, despite their lower average IQ, under the guidance of Dr. Raju.

No doubt mere amateurs in comparaison to Dr. Chokwelamumba, imported fresh from the Ebola fields of Liberia by your local "Christian" church under the Federal Refugee resettlement racket (for which these selfless servants of the Llord Bankstein are well paid), to practice "traditional" medicine.

Nate probably has some good insider info on this too. There are a lot of moving parts to the degraded healthcare system such as:

1. Some of the docs I know personally or have worked with have said they would discourage someone from a medical career. Others were more explicit in saying if you have a passion do it, if you're doing it for the money, which a lot of incoming students are, then skip it. 2. I also know of at least four docs who have started side successful side businesses because they want out of a system that discourages good health care.3. My primary quit working for a large PC conglomo and bought a practice from a retiring doc, just so he could get away from corporate medicine. 4. The amount of shit a doctor has to take from government is astounding. With the advent of the aging population and now ACA, Medicare has a huge say in treatment, reimbursement, and forcing Primary and Specialty groups to adopt very expensive and questionable electronic record systems tied into ACO's (Accountable Care Organizations).

I could keep going. The system has become so complex that it is now extremely fragile.

The most likely solution is to relax the accrediting standards for med schools, which should have been done back in the 1980s.

Even the journal of blacks in higher EDU admitted that without affirmative action there would be no black medical doctors if merit placement was used.http://www.jbhe.com/news_views/51_graduate_admissions_test.html

There was another recent chart showing blacks are so many times more likely to be accepted to med school for the same MCAT score as Asians and whites. I have talked to white guys thinking about being doctors and have explained that they have to be at least 25% smarter than the non Asian minorities in their class, and that they should consider PA school, and that nurse anestisists can (take home pay) more than primary care doctors http://www.payscale.com/research/US/Job=Nurse_Anesthetist_(CRNA)/Salary, Oh wait no skills needed $140k+ job http://www.washingtonexaminer.com/state-dept.-hiring-interior-designers-salaries-up-to-141000/article/2587055

I have noticed malpractice seems to happen more with non Asian minority doctors. One of the most annoying things for doctors is arguing with someone who might only have a high school diploma working for an insurance company, on the phone about the necessity of a medical procedure.

running a medical clinic. One is "Don't have to many Medicaid patients or you'll go broke,"

Build it where busses don't run to.

They've had programs for years that pay for part or all of med school if the student agrees to a certain number of years of service in the rural

Harvard med has remedial biology classes for its blacks, but they take up slots for people more likely to pass boards. The problem with putting crap students through is that it will naturally lower the standards of boards even if people don't actively attempt it.

Wouldn't having primary medical care be considered in the American national interest?

We're told it's a fundamental human right. As with the conflicting and mutually exclusive -isms of the Narrative, it'll be interesting to see which human right wins in this case -- the right to health care or the rights of immigrants.

Anyway, not to disparage the good doctors who are out there and the people who genuinely need them, but this shortage isn't necessarily a bad thing. Americans seem to have this attitude that they can live ridiculously indulgent lifestyles, and they can deal with the consequences by seeing a doc and getting a prescription. The current medical system is set up in such a way that doctors are discouraged from insisting on behavioral changes and are instead encouraged to prescribe, prescribe, prescribe. One of my Boomer relatives has an army of doctors and is on sixteen different prescription medications -- none of which actually improve her health -- for the simple reason that she refuses to quit her bad habits. Well, when you have to wait for months and months to see a doc to get a prescription, taking responsibility for your own health will seem like a good option.

@9 Spot on Salt. The great unwashed don't realize that a doc or facility get just a negotiated fraction of their billed rate. This is one of the reasons why you get billed $20 for a mucous collection system (box of kleenex). The billing and accounting behind this is all smoke and mirrors.

@11 During the time a close relative worked in the MD/PHD program at a state university. (This program takes the best of the best med students to get both an MD and PHD. It's a feeder into their medical research pool from which the school hopes to make bank on medical patents.)

At the time said relative worked there, the program had no black students and few women students.

A college friend of mine was a rural primary care doc, exactly the kind they bemoan as disappearing. He had his own practice. He looked at the changes in the insurance industry and shifting cost structure, and he sold his business when he realized he could make more money as a bee-keeper than a doctor. *that's* how screwed up our insurance system and legal system has gotten: a medical doc can make more in agriculture, with many fewer headaches and a better schedule.

Haven't seen a white doctor in my city for a decade at least. Plenty of whites in plumbing and pest control though, doing the jobs immigrants won't do, and getting paid more for them. Evidently whites clean shit better.

GPA 3.5 MCAT 30 acceptance rates: Asian 50%, White 55%,Hispanic 80%, Black 91%, but despite these numbers this article that has the numbers says"Why Are Blacks Less Likely to Get into Medical School?" http://www.medicalschoolsuccess.com/how-hard-is-it-to-get-into-medical-school/But eventually admits that "Whites have the best scores and Blacks have the worst scores."

At the time said relative worked there, the program had no black students and few women students.

Sounds like every OR in the country, surgeons have to stand for long periods which doesn't work out well when on their periods, and have rough schedules that wives divorce them so they can enjoy 1/2 their wages without having to leave the opera just because a school bus flipped. Even the UK admitted that women doctors don't put in as many hours as men.

Most med schools have expanded class sizes, to the point where American M.D. grads are on track to outnumber residency spots in the next several years. The big bottleneck at this point is residencies, which hospitals have successfully bilked the government for since 1965.

Hospitals make a bunch of money off of residents, but are generally unwilling to foot the bill for training themselves, since they have been able to get the government to pay for it for a while. In the 1990s, Congress capped the number of residency slots, and also essentially cemented their distribution (disproportionately at academic medical centers in the Northeast).

There have been some attempts recently to recruit students from rural areas in an attempt to build a better pipeline for rural primary care, and they've been anecdotally successful. The National Health Service Corps, which gives loan forgiveness (~$40,000 per year) in exchange for working in underserved areas (many of which are urban) tends to fill most of its slots, but the program is relatively small.

Primary care has also become a less desirable field to work in. Primary care residencies are the most open to foreign medical grads, and the scope of practice of primary care overlaps far more with PAs and NPs than the more procedural fields; both of these mean reduced job security and concomitantly lower salaries. The expanded use of "allied health professions" has pushed many primary care physicians into a more managerial role. The doc-in-a-box urgent care center seems like the endpoint of the current trend, and most physicians I know are not terribly enthused about that.

In the past decade, even more so in the last 5 years, most physicians in independent practices have become employees for local healthcare IDN's. They essentially lose all the influence and power they had in practicing medicine their way. Treatment and/or the technology/tools needed for that treatment are decided by many HS, and some college-educated, hospital employees that are essentially glorified stocking & inventory clerks. These folks almost always have zero clinical experience. The trade-off for the surgeon is the relief they get from having to deal with all the BS of running an independent medical practice in our over-regulated, insurance driven healthcare system.

Hence the advent of "concierge" medicine. Doctors are creating their own "membership" clinics. The doctor has one-quarter of the patients and makes three times the money with NONE of the insurance hassles. And be even gives you his cell phone number and makes house and office calls!

Cost? About $100 a month.

Also, do you even need insurance? Maybe not. Here's a great video from a doctor in Alameda.

WWW.truecostofhealthcare.net.

Dr. Belk tells the truth about malpractice insurance rates and the cheapest place to buy drugs (Costco).

Another large contributing factor is the higher percentage, and in some cases majority, of women in medical school classes. Very often, women doctors will get married and pregnant and lose the drive to work 60+ hours a week. Also, few women are really interested in working such long hours regardless. It requires an enormous investment to train a doctor through medical school and especially residency. Many women doctors never practice enough to return that investment back to society at large, and they took the place of a male student who would have likely more than returned the investment.

Harvard Medical School figures that the first time in history when doctors did more good than harm was around 1940, just before penicillin was discovered...Doctors killed George Washington, Charles II, and innumerable others....I think they may still be overrated....

Get 400k in loans to go to med school and be completely phased out of any interest deduction because your starting pay of 120k is too high. Go to school for 10 years to Work 80 hours a week to take home 58k after taxes and loan payments (5% 15 years). Yeah, that's not worth it. And those are fairly optimistic assumptions.

@25 I used the app iTriage to save my brothrr-in-law's life when his Muslim Pakistani doctor wouldn't perform tests and wanted to send him home because he was afraid the insurance wouldn't cover his stay!

"The most likely solution is to relax the accrediting standards for med schools, which should have been done back in the 1980s."

And the first step in that regard is to let white males back into med schools en masse. I know of a number of white males with outstanding MCAT scores and good grades who were delayed into MD programs (or had to go DO) all because women and hispanics with lower scores got preferential treatment.

I work for a prestigious health organization in the twin cities. I've had the chance to talk to many of the residents who work in primary care. None of them want to continue in primary care when their residency is done. I think it's thought of as the lowest you can get on the totem pole. everyone wants to practice in hem/onc.

here's another hilarious thing. when I schedule people's appointments, I offer the soonest available, which is usually with some obviously foreign doc. most are fine with it. some people boldly ask for the first available appointment with a white American male Dr. I assure them I completely understand their preference, and offer the next opening with a white American male which is usually 5 months out.

The overproduction and critical shortages are artificial. They parallel the pricing problem in the Soviet commonwealth as explained by Mises. Rather than people starving while potatoes rot in the fields, we have businesses starving for talent while CNC machinists are picking up overnight jobs at Kroger to make ends meet.

It's because in America we treat corporations like people, people like commodities, and job training like factory production. More steel comrades!

There are (very, very roughly) 750,000 doctors in the US now. So if we lose a million of them between now and 2025 we're gonna be in real trouble.

The study that the MarketWatch article links to doesn't say anything about losing doctors, but rather the growth in supply not keeping up with the growth in the demand - leading to a shortage of up to 90,000 doctors from what will be needed. I think I'd better stop buying stocks based on MarketWatch stories.

The numbers are stark. Since 1970 (I may be off on the exact year) the US has opened 50-some law schools and ZERO medical schools. The result is an overabundance of lawyers and an underabundance of doctors. Restricting the supply of doctors is a wonderful way to raise doctors' incomes.

I am in the medical field (podiatrist). A few weeks ago I was at a 3 day continuing education seminar. Most of my colleagues were doom and gloom. I heard the best days are over, I am getting out, pity the new grads, don't let your kids follow you. Most of what is driving it is electronic health records and onerous provisions contained therein the 2009 Stimulus Act. Medicare will penalize a doctor 7% starting this year for not having the right software. The federal government is gathering information from this software on height, weight, race, gender, medications, allergies, past medical history, smoking status, family medical history, surgical history. In the PQRS measures, I have to record show size, does the shoes fit properly, did the patient get a flu shot, did the patient get a pneumonia shot. If not, I have to recommend they do. I have to record blood pressure and follow up on that. I work on feet, I am not internal medicine. You report this info in February every year or get penalized. The EHR/PQRS/Meaningful use measures were designed to destroy private practices. The Feds want all your doctors in big, hospital run systems. The U.S. Federal government view has been it is easier to control a few big entities than a bunch of small ones. Obama has made statements about the medical field (pediatricians doing tonsillectomies for money, my profession amputating feet for giggles etc). He despises the medical field. I have my suspicions that deep down he knows he would not have been to hack it in nursing or medical school.

The most likely solution is to relax the accrediting standards for med schools, which should have been done back in the 1980s.

The way Detroit solved the black-white gap in math scores was by giving the students the answer sheets for all of their homeworks, then grading them solely on completion. I figure we'll see something like that here.

Forbes wrote:The numbers are stark. Since 1970 (I may be off on the exact year) the US has opened 50-some law schools and ZERO medical schools. The result is an overabundance of lawyers and an underabundance of doctors. Restricting the supply of doctors is a wonderful way to raise doctors' incomes.

See, this is what I'm talking about. You can also find articles explaining that you shouldn't study law because the job prospects are awful.

I'm telling you guys, it's the Socialist pricing problem all over again.

If you guys knew how screwed up our medical system is, you'd never go to a hospital again. Physicians have collectively allowed the field to be destroyed, as they surrendered control of medicine to bottom-of-the-barrel MBA's and herds of morbidly obese middle-management heifers.

The accreditation bureaucracy has done a good job of limiting physician supply, but that hasn't translated to rising physician wages. Medicare, on a good day, pays $0.20 on every billed dollar (Medicaid even less). The average doc pays 50% of that to overhead, cuts a check to Barry Obama and fedgov for another 50% and is still loathed as "rich." Only those who enter highly competitive and desirable subspecialties can do well, and then only if the practice is invested in surgery centers, MRI, and other ancillaries. Of course, Repuke congressmen likely Grassley are always on patrol for any doctor who might be making money, and pass laws to limit ownership of those services. Witness the ACA and the ban on physician-owned hospitals, which provide better care by the governments own standards!

Instead, they're funneling docs into employed positions in which their work output has nothing to do with pay, which is instead based on vague patient surveys, arbitrary quality metrics, and how much the fat HR lady likes you.

The way Detroit solved the black-white gap in math scores was by giving the students the answer sheets for all of their homeworks, then grading them solely on completion. I figure we'll see something like that here.

Restricting the supply of doctors is a wonderful way to raise doctors' incomes.

You'd like to think that, wouldn't you. But it's not the case. What is had done is dramatically increase the costs of med school - tuition for the four years at decent schools is north of $50K/year for four years. Between undergrad and med school loans, you could have a tidy $300K to pay back as you enter the labor market. Between med school and residency you've given up a decent income for 7-10 years. And as mentioned earlier, your income is just high enough so you can't deduct that student loan interest either.

Think of the type of business you might start with that $1 million in lost income.

From years of experience, physicians aren't as smart as they think they are. It's no secret they make a lot of money, so they're constantly being scammed. Which apparently leads them to view everyone with suspicion. All in all they can be rather pleasant.

From years of experience, physicians aren't as smart as they think they are. It's no secret they make a lot of money, so they're constantly being scammed. Which apparently leads them to view everyone with suspicion. All in all they can be rather pleasant.

Actually medical schools have been opening: Stryker, Beaumont, Commonwealth in the Midwest; Dell and TCU coming to Texas soon. Bottleneck in supply is definitely the residency slots.

I do agree with a previous post that doctors are not as smart as they think. There's a really popular book and blog called White Coat Investor which explains basic (VERY) finance to people who go into medicine. Frankly, after I read it, I laughed. It was kind of sad the financial situation my peers get themselves into.

It is also true, doctors are becoming increasingly liberal. Just seeing any medical school graduating class will tell you that. That boils down to admissions, another group of PhD bureaucrats who have way too much poz to actually pick a proper class.

No one has mentioned how senior doctors are pushed out by continuing education requirements, needing to recertify in each state, and each new position requiring original letters of reference from every place you ever worked for even a day, stating you had no malpractice. Each time a doctor covers another doctor at another hospital who is on vacation, "locum tenens", the stack of paperwork gets larger. A couple of years of locums work and you're virtually unemployable.

This pushes the most experienced doctors out. Once they're out for a couple years, because of the continuing education and other requirements, it's almost impossible to get back into active practice.

We need a national licenseure system that is designed to allow good doctors to practice anywhere and without onerous requirements.

Just FYI, I literally almost got expelled for basically not being able to keep my mouth shut about how pozzed everything was. "professionalism"I had this black mark applying for residencies about that. The people running residency programs loved my numbers (high, let's be honest, I'm male) and interviewed me. Once again, their rank committees dropped me low, and I ended up at a mediocre program that came with a 30k bonus to live in the area (Rustbelt city). funny how low life works out - I get paid extra to not be in a Kool Aid environment

This may actually be good for America. MDs admit to killing 300,000 people per year. Using CDC standards that for every case you see there are 10 unreported, this could be as many as 3,000,000 people per year.

A couple years ago it was stated that the three top death categories were all doctor related. Vaccines, unsafe drugs, doctor drug pushers, enforced lack of alternatives to MDs and Pharmacueticals are all killing Americans.

All the while the MDs and BigPharma try to deny Americans access to safe, natural remedies which have been used for thousands of years. MDs need to be delicensed and let the marketplace dictate which types of medicine the people wish to pay for.

My Primary Care Physicians went Galt. They have a practice where they only accept cash, but for a fairly low monthly fee, I can see them whenever they are open, and they have a basic Pharmacy that all the common drugs are dirt cheap. So the doctors, nurses, receptionists are guaranteed a salary, and I'm guaranteed access, including via text, email or phone (should I go to the ER? - I'm feeling queasy, what do you recommend). They also do some wellness stuff.I still have to have a catastrophic policy and I have an HSA, but primary care is covered, and I don't have to worry about going through a dozen "insurance will pay for it" tests.

Gee i never remember us having this problem before Obamacare introduced "fair" medicine which shortchanged doctors and people who pay for insurance to pay for freeloaders mowing the lawns of the Rich. Could there be a correlation? Some say correlation does not mean causation, but what they really mean is they have the Math skills of a monkey. You are not arguing a case in court, if you see a marked increase in something or the sudden appearance of a major issue after a major policy change, it should be sufficient to require an audit of that policy and possible rollback of regulations to see if they have a marked negative affect on the people they regulate.

EH wrote:No one has mentioned how senior doctors are pushed out by continuing education requirements, needing to recertify in each state, and each new position requiring original letters of reference from every place you ever worked for even a day, stating you had no malpractice.

Same complaints in every field, from programmers to math teachers. Cost of education is going up, employers can't fill positions, graduates can't find jobs, quality of trained workers is going down, and older people are being pushed out.

There are pockets of capitalism that are allowed to exist to keep the system afloat (petroleum and trucking mainly), but everywhere else it's corporate socialism.

@5 John Williams: "The reason a small subset of patients can do so much economic damage? They go to the doctor often because it's free for them."

Back when I tried being a good churchian, I volunteered to help an elderly individual. I was assigned a Haitian (in the US since the 1960s) living in local subsidized housing. She had 3 kids and numerous grandchildren, all with vehicles, but no one to take her to her unending doctor's appointments. For almost 3 years I drove her to one appointment/hospital after another. I gradually realized the requests for "hep" never ended, that her own family couldn't be bothered to lift a finger for her, and that she was unwilling/unable to change her own behavior. Since being a cuck was incredibly stupid, I stopped.

@24 Tom K.: "I used the app iTriage to save my brothrr-in-law's life when his Muslim Pakistani doctor wouldn't perform tests and wanted to send him home because he was afraid the insurance wouldn't cover his stay!"

My close friend's 81 year old mother is just finishing up a 20 day hospital stay (to be followed by 10 days of rehab stay) because the doctors ignored every symptom and every question regarding possible damage to the Vagus nerve. (My friend is a certified electrologist and as such is required to take tons of continuing ed classes, many intended for PAs etc., she's far from stupid or ignorant, and she researched her mother's continuing problems/symptoms online.) Insisted she didn't know what she was talking about and NO WAY did he damage said nerve during gallbladder/hernia surgery. Of course, after her mother almost died because her stomach ruptured (while she was on blood thinners because she had just had a heart attack and stents put in) because the Vagus nerve was not working properly, and subsequently had to be severed, the doctors are trying to make real nice to my friend. If she were the type (she's not), she could sue their backsides off. Either way, we're talking an old and very sick woman and hundreds of thousands of unnecessary dollars in costs.

While I respect those doctors who have education or skills that I lack, I regard the doctor/patient relationship as nothing more than a commercial transaction. I'm purchasing services, not beseeching an oracle. If a doctor doesn't get that, I look for a new one. I changed doctors frequently when my sons were young.

I have an auto immune disease that affects my breathing. I was working with a pulmonologist. His idea of treatment seemed to be drugs with bad side effects and invasive tests like a bronoscopy. I told him that I simply couldn't afford the testing. He sent me a certified letter warning that I might need a lung transplant if I didn't cooperate.

My current insurance doesn't pay for much but it will let me use a naturopath. I have the equipment to monitor my own oxygen levels. I can tell when treatment works and when it doesn't. I realize that many people think of naturopaths as quacks. They don't seem to understand that many doctors are too. And taking a medication that can cause thigh fractures may not be the best way to treat bone loss.

The most likely solution is to relax the accrediting standards for med schools, which should have been done back in the 1980s.

Don't forget to trim all the worthless classes that have nothing to do with becoming a good doctor yet suck years and tens of thousands of dollars from students.

I have several female friends who are becoming nurses. The first few years of their education consisted of the typical gen ed nonsense including:

* 5,000 word essays about obscure literature.* Hours of lectures about racism.* Days of studying about sexcism.* Never ending quips about how stupid the Bible is and how Christians in flyover country need to die.* 10,000 word essays about how whitey is evil and needs to die.

I've heard stories that would make you want to grab pitchforks and torches and burn the institutions straight to the ground. And this is for a nursing degree. I can only imagine what goes on during the extra years to become a doctor.

If I was graduating high school this year I would never, ever consider becoming a doctor.

Does anyone know of a website that lists doctors like this? I need a new primary doc.

I love mine, but she's a pain to get to see and her NP is an obnoxious cow-worshipping bitch. And she seems incompetent. She said I had a perforated eardrum and the otolaryngologist said he saw nothing of the sort.

(Side note: how do I know better than my browser's spell check how to spell "otolaryngologist"?)

As far as I know, Cuba just wants to be paid for training its doctors. Each year they graduate many (it's about the only thing they do well). This sounds like making a deal with the devil, but a system could be set up where a US bank loans money to the Cuban doctor, who writes a check to the Cuban govt, and they allow him or her to move to the USA (in debt just like every doctor starting out). They could specialize in Spanish speaking patients, even

Somebody tell me what is wrong with this plan, it might even get Cuba addicted to Capitalism ...

John Williams: "The reason a small subset of patients can do so much economic damage?

There are homeless patients that use ambulances as taxis, and because they can't stay in homeless shelters because of bad behavior will sleep in ER waiting rooms. Those ambulances cant be used for patients in emergencies, like white people hit by illegal alien drunk drivers. I had the same illegal alien drunk driver as a patient 3 times.

becoming nurses. The first few years of their education consisted of the typical gen ed nonsense including

Its come full circle, colored people time is recognized as a cultural time preference in newer nursing books. You also forgot watching crappy Hollywood/lifetime movies

I openly discourage any college student who asks me to NOT attend medical school. Doing my primary care rotations were enough to disuade me from going that route. I will echo the sentiment about women though. They are ruining the profession. Don't get me started on the immigrants. It's awful.

What is happening in the medical field is very similar to what happened in the veterinary medicine field decades ago. I knew a few guys who sat on the admissions boards back in the early 70's and they were under pressure to admit more women into vet school but resisting it because they *knew* that giving the slots to men would mean the slot would go to someone who wouldn't decide to quit in order to get married and have babies.

Those guys were removed from the admissions boards and women flooded into vet school. For those who don't know, veterinarians are traditionally trained on 5 animal models: the cow, horse, pig, chicken and dog, all of which are agricultural animals. Now-days vets choose a specialty. A DVM used to be one of the few degree programs that required the student to think and be problem solvers and yes, there's a hell of a lot of diagnosis by treatment.

So all these women flooded into the vet schools and as predicted after working some years they decided to get married and have babies and only wanted to work part-time. Veterinarians tend to be ruthless businessmen and thus by the early 1990's a veterinary degree was the lowest paying doctoral degree one could get. I dated a woman who had a BA in chemistry and a DMV looking at a starting salary of about $24k as a vet and $34k as a chemist. She chose to go the specialty route and became a Diplomat of the College of Lab Animal Medicine (DCLAM). She is now married to a doctor, has kids, lives in podunk TN, and works part time at a large animal practice to keep her credentials current.

Another female vet (an employee- I wasn't dating her) got hired to *be* a lab animal vet working primarily with mice, rats, rabbits, dogs, mini-pigs and monkeys. After about 2 years of OJT and a lot of study on her part she was competent but lacked the strength to handle the pigs or the monkeys safely. Monkeys are the worst because the Simian Immunodeficiency Virus (SIV) is deadly and a full-grown male rhesus monkey (~20 lbs) is more than a handful for most men. Which meant that the guys (lab animal technicians) were doing the real work. They typically had a bachelors in biology and studied the same stuff the vet did and got just as competent as our lab animal vet (and then more so).

This all came to a head when we had some medical device studies that required surgery to do the implants and occasional surgery to deal with problems. It turned out that the survival rate on the surgeries was better for several of the non-vets than for our qualified, certified, credentialed surgeon who damn near had a nervous breakdown when the results became obvious. We wound up focusing the training on the technicians (better quality of care at a lower cost) with her in a supervisory role with a nice raise. That required that we keep our quality assurance people on a short leash because they were so incensed that an *unqualified* person was performing delicate surgery.

I think we're seeing the same thing in the medical field today and it's following the same pattern. The problem there is that instead of animals we're talking about people so the credentialism is off the scale. The reason for that is while animals don't have a choice, people do. With a little training there are a lot of nurses that would do a far better job at a much lower cost for the vast majority of problems, which gives the highly credentialed folks in white lab coats a fit.

I will say this, I don't quite understand why the U.S. makes their doctors go to undergraduate school. I get needing some prerequisite courses, but on the whole, there wasn't much I learned (if anything) that I needed an undergrad degree for. I double majored in chemistry & mathematics along with whatever biology I needed to sit for the MCAT and nothing I learned in differential equations or physical chemistry had any bearing on my medical school performance. I know I was volunterring in surgical wards when I was 15. I'm not saying I should have been a practicing physician but following around surgeons for 15 hours a day all summer long for a couple of summers helped me immensely in deciding to be a doctor. Going to med school at 16-17 years of age makes a lot more sense to me now. I guess there are maturity issues there as well, but as far as the hard sciences are concerned in med school, I'm not sure I couldn't have done that at 14 years of age. Why go to school for 8 more years to learn stuff I could have learned a lot earlier? I have mixed feelings now as a physician.

I sat on our admissions board for a year as a student & it was amazing to see how dumbed down everything was. I went to a state school and if you were a minority state resident then as long as you could read & write, you were almost guaranteed a spot in the medical school. I know state schools give preferential treatment to in-state residents but letting black women in with 2.5GPA and a 22 on their MCAT seemed criminal to me. Of course I was told they would be excellent students because of the unique experience they could bring to the medical field.

Baseball Savant wrote:I will say this, I don't quite understand why the U.S. makes their doctors go to undergraduate school. I get needing some prerequisite courses, but on the whole...

You're not thinking about this the right way. You are thinking of the optimal way to produce a doctor, which is far too logical. Think of it from another perspective:

Education is a business that sells a product - credit hours. Furthermore, now there is a financing component which increases profits - student loans. So, while your way would produce the same outcome or better at a lower cost, there would be less money flowing to universities to pay $500k salaries to administrators, $400k to law professors who teach one class, and the like. Those people are powerful, and furthermore have inserted themselves into a place where they can influence opinions for a reason, and it ain't to do the best job they can. It's to gather money and influence.

Just remember, while there's no master plan, things are not the way they are by accident, no matter what people say.

That is reflective of how society chooses to rank its priorities. By letting those women in, society has stated that racial justice is more important than having the best doctors we can given our budget. Considering that intelligence is directly and strongly correlated to job performance, including mistakes, that means that we have said as a society that appeasing the black community is more important than our overall level of medical care and safety.

If this sounds irrational, then it is. But then again, we need to realize that progressivism is actually a religion, which explains why so many of them don't seem to have any type of religious faith. Well, they do, they just don't know it.

That's because liberals have a tried and true formula for taking over industries. They work their way up into positions of authority and then simply refuse to promote anyone who doesn't think like them. Nobody ever talks about it or leaves evidence, they just ruin your career or don't allow you to start one, as in this case.

Conservatives don't understand this because we don't tend to take someone's livelihood away from them because they are a bit SJW. This gives liberals a MASSIVE advantage. Try going into academia, entertainment, or media as a conservative and see what happens.

Speaking of Dr's not being as smart as you'd think; I've asked several of the ones I work with "what do you do if you can't figure out what's wrong with a patient?" They usually tell me they Google their symptoms, skim the wiki (with the patient in the room) and then try to sound like they know what they're taking about.

people don't go into primary care anymore because it doesn't pay the bills. our family owes half a million in medical school loans. my husband attended an out of state medical school because our medical school was only taking out of state applicants. out of state tuition costs more. a lot more. however, if you are a foreigner or an illegal immigrant, you automatically get in-state tuition rates. so when a person owes that much in loans, are not able to earn their first dollar until they're in their mid-to-late 30s, they HAVE to go into higher paying specialties. students are going into the highest paying specialties their IQ will allow. the higher your test scores, the higher the paycheck, more or less. the bottom of the IQ barrel (affirmative action) go into primary care and i have no idea how they will ever pay off their debt. so as long as students owe half million upon graduation, they will be forced to go into higher paying, ultra competitive, high IQ specialties.

my sister is a nurse practitioner and they handle lots of primary care. but there are not a whole lot of NP programs out there. maybe focus in this area. they also get paid the same as primary care doctors but owe about 80K after graduation versus a few hundred thousand.

preventive care is very important too. i can tell you right now, the healthcare system is clogged with the underclass of this country. drug addicts, obese diabetics, alcoholics, losers getting into fights, drunk drivers, lots of chronic conditions from a medley of all of the above. these people are not normal people. the biggest burden on the system are these people who don't even care about themselves enough to put down the cigarettes, the crack pipe and eat an apple. if it weren't for these people, the hospitals would be a lot less full.

*If I need an operation, I'd rather have an artist or athlete with steady hands do it than some "doctor" with book smarts*

you are ignorant. my book smart husband "doctor" will have spent 6 straight years with intensive surgical training (after 4 years of medical school) before he's running his own practice in orthopedic surgery. you need to know where nerves, vasculature, etc are to avoid nicking. you also need to know whether to approach from front, back, side, etc. plus the process usually weeds out "unsteady hands" by virtue of the person showing they can't "cut it" (no pun intended) during the years of training... but if you want a dumb athlete who can sink a 3-point shot from half court, then be my guest you unappreciative fool.

@38...Without a good primary care physician, there is nobody to tie all the specialists opinions and test results into one cohesive diagnosis. Anecdotally, I was referred to one specialist after another, including clinics who simply provided MRI's. In each case, it was wait two weeks for an appointment, then wait another two weeks for the test results, then a big question mark as to whether my revolving cast of so-called primary physicians were able to receive the results and make any kind of comprehensive diagnosis for what I had. This became so time consuming, and expensive, and ultimately nonproductive, that I took the advice of a friend and went overseas for medical tourism. Best decision I ever made. Choose the right country, and you will be cured and your overall medical expenses will be low. Fuck the US medical system and fuck the US government. Both have been broken for much longer than any of us care to admit, and there is no way to fix them.

Nah, Were-Puppy, they fail at the get go. Most of my son's High School associates are sitting around wondering why things are going the way they are. My son got his MSEE and has no problem getting work and is doing better than me. He started as an enterprising skull full of mush and it didn't take much to keep him on track. So many Millenials and Xers are simply worthless by comparison.

That might be a great one for the beach. I am still waiting for HilLIARy to steal the dem nomination, before having the Clinton/Gore 92 confederate flag button with "Hillary took $40mill from nations that execute gays while secretary"

"Thanks. I'm not saying take an athlete off the court and drop him directly into the operating room. He would still need the surgical training. Just not a 4.0 GPA."

as if the GPA or the test scores are meaningless? those things are the measurements used in a meritocracy. the GPA and test scores tell us the person's IQ and perseverance. which in turn tell us if the person can even survive the surgical training.

you can have high IQ and low perseverance like an unemployed MENSA artist. you will fail surgical training. and you can have high perseverance but low IQ and just not have the brains needed. you will fail surgical training. so the GPA and test scores tell us if you have both, IQ and perseverance.

and to separate yourself even further in this ultra competitive process, if you are additionally an accomplished artist, football player or army ranger you will be chosen over the just high IQ and perseverance group.

My wife has a Ph.D. in ME. A lot of Arabs and Indians were fellow classmates with her during her studies over the past few years. I got to know many of them. All of them cheated their way through the courses and some of them even had others write their dissertations.

One fellow from Iran was with her when she took the qualifier, an exam need before one begins research and writing the dissertation. My wife told me that he was on his I phone the whole time with a friend getting all of the math questions completed for him.

I had a conversation with one of the Professors on her committee over dinner. An Indian man of about 70. Nice man. He was totally aware of the cheating amongst his pupils, also brutality honest about racial issues - literally beyond confused regarding our immigration policies and why Americans tolerate it. He mentioned that he preferred his White American students. The Professor said he admires them because they did not do study groups and share answers with each other. Rather they were more solitary and honest regarding assignments and class projects. In other words they had integrity that was lacking amongst his foreign students.

"This is all bullshit. There is no doctor shortage, just as there is no shortage of engineers or computer programmers."

there is not engineering shortage. in fact there is a glut. There very much IS a doctor shortage. Its just not showing up that way right now because its the trend they are worried about. They aren't worried about patient care today. They are worried about 10 years from now. Because it takes over 10 years to get them trained.

Right. the Drs get together to discuss clever answers on how to make me look stupid, and they settled on "tell him we use Wikipedia, that'll sure make him look like an idiot". I spend hours talking to the residents, the question comes up naturally in conversation sometimes. more than one has admitted to using wiki. I know your wife is doctor, you don't have to get offended, I wasn't talking about her.

Darn – I got here late to this one since I was out shooting all afternoon.

I'm a pediatrician and I don't use Wiki's or Google. I use www.uptodate.com - it's peer reviewed and footnoted all to heck with references which keeps my malpractice insurance providers happy.

I see you're talking about residents. Big difference between a resident with 1-2 years of experience in their specialty vs a practicing, board certified doc with many years of experience. The residents really do have to pretend since they are still learning.

I’ve found that admitting ignorance helps build trust. If patients know you’ll admit ignorance, they are more likely to believe you on something you’re sure of but they may not like. Such as the mom who would really like an antibiotic to make her kids cold go away, but trusts me when I tell her it won’t work.

The current medical system is set up in such a way that doctors are discouraged from insisting on behavioral changes and are instead encouraged to prescribe, prescribe, prescribe.

Most of the families I see WANT the prescription because it’s seen as being easier than the work of changing their behaviors. It’s not the system forcing the prescription, it’s the patient.

Most good primary care physicians would prefer the behavioral changes but really have no control over them. I spend quite a bit of time talking people out of meds and into behavioral changes – only to have them come back 2 months later having made no changes and still demanding a pill.

After two or three cycles of this the tendency is to give them the med up front and save yourself the wasted time of teaching them.

Oh, as an aside, doctors do NOT get kickbacks from pharmaceutical companies for prescribing medications. I’ve seen that mentioned here before and it’s not true.

Some people are unmitigated idiots, and need to be called on it. You are such a person. Each and every problem with US medical care (I refuse to call it "healthcare") is due directly to government interference. Even before the obamacare debacle, the insurance industry grew to be an untrustworthy behemoth as a direct result of government regulations. Under those ever-increasing mindless rules, each year medical care delivered less quality for increasing costs.

If you really want to get off your ass and learn something about reality, people such as Karl Denninger have done extensive research. In his case, he is just aspie enough to deliver the occasional lengthy screed on his blog that will enlighten the interested reader. He delves into all aspects of how government intervention and regulation have throroughly ruined medical care in the US, to the benefit of nobody.

Screaming about "crony capitalism" is so banal, so trite, such mindless kneejerk leftist propaganda, that anyone who does it is a doddering drooling old communist like Grandpa Sanders spouting predictable leftist bullshit. Be sure to wipe up the drool from your keyboard before you log off.

"After my many heart problems(valves, AVEB, HBP) all I see are Nurses, Nurse Practitioners, and Physician-Assistants."

who are all supervised by doctors.

What Nate said.

In pediatrics it's worse. Most urgent cares are staffed by PAs or NPs with little to no pediatric training. I tell my patients to avoid them like the plague. It’s probably 50/50 on whether they get everything right at a visit. Either the diagnosis is wrong, or the treatment is wrong, or medication is wrong, or the dose is wrong or sometimes ALL of them are wrong.

And yes, some of these extended providers are really good – but the good ones know when to call for help from the doctor supervising them.

Been working in the hospital setting for a while now, because I enjoy a challenge, asked my director to give me a tough assignment. Huh. He certainly came through on that request. I work as a problem solver. Gave up years ago solving other's problem's directly, although the problems and solutions seem obvious to me, it rarely worked unless they came up with the solutions themselves.

The hardest part is taking the smartest people (surgeons, heads of various hospital units, CEOs and Vice Presidents etc.) away from immediately diagnosing the symptoms and prescribing a solution. Now I'm vastly overbooked as more units in the main hospital and other hospitals hear about the results and want something similar.

Anyway, I think many of you have no idea how seriously screwed up our entire medical system is right now. And it won't be getting better in the next 10 years. The head physicians come to me now with their problems to help them get clarity on what exactly is wrong. I've learned to never dialogue with them if women or especially nonwhite women are within earshot.

Residents are almost entire Millennials. Their work ethic, for the most part, is CRAP! They whine if they have to work more than 10 hours. As 1st year Residents. And yes they use Wiki, but it is a very specialized Wiki for medical usage and is actually quite good.

Now admittedly my IQ is far above average so I don't really expect to have too many residents impress me with their intelligence, but we have about 60-65% females and a handful of foreigners, and I am not impressed with their intelligence. But the women are usually quite smartly dressed and look well-rested and made up. So at least they have that going for them. And it is pretty clear from their body language that they enjoy wearing the white coats.

The white male physicians treat me with decent respect BEFORE they even know why I'm talking with them. The women are quite skeptical and standoff-ish. Until they find out the top 3 MDs treat me with respect, including the one who is a childhood friend. Women. Put in a white coat, and they're still women.

Also, pregnancy leave, unwillingness to work extend hours, demand for regular time off....Oh, and one of the female surgeons is always late for the first surgery because she refuses to miss her early morning yoga class. I am not kidding. Our OR costs $35 per minute (at least), so a 10 minute delay just cost the hospital $350.

As mentioned several times above, the Medical (Medicare) reimbursement rates are really bad. And of course in any "blue" city, you're going to have lots and lots of Medical patients. We are only kept afloat financially because of the commercial patients and their insurance.

But many of the indigent and minority patients run up the bill to the sky. On your dime.

I train docs. What you say is fairly correct: In NZ the hours are limited (72h max a week) and the surgical trainees sneak in extra hours... my specailty (Psych) is lower hours for darn good reasons -- I did medicine before psych and a medical OP clinic left me rested while a psych one exhausts me (the stupid it hurts).

But son 2 is doing Health Sciences Year 1, which is a post school year leading directly to an MB. Bumped into an elder from church today who is a GP. He commented that he needed to work hard as we need more male doctors.

Longer talk. Neither of us blame the girls for wanting to be wives and mothers. But that means you need three girls for every guy. And the classes are 2/3 female: most of the girls forget that biology hits women's fertility before guys.

And that is without the US stupdities: I have not worked in that system. But a fair number of senior docs over here trained in the US and left the US, taking a large pay cut. to work in NZ. Because of less hassle and more control over what they do.

A large amount of the problems in the US are related to the way you structure things, and your inability to learn from other places. Like Australia and NZ, or Germany, or France.

Since the topic is about doctors and the medical system, what would happen to the medical field if all insurance, public or private, was abolished? I've always wondered what the real costs of medical treatment would be if it wasn't propped up by medical "insurance" aka transfer payments from the healthy to unhealthy.

Farily easy to answer.1. Cash on the nail for most.2. Friendly societies and unions for some.3. Charitable wards, run by interns and residents, for the remainder.

That works when the government gets out of the way. In the more advanced parts of the world, the mad house is a true asylum and provided (and will provide) shelter for the crippled and demented and simple (the mad need the asylum less than these groups).

In the less advanced places, such as San Franscisco, the infirm and crippled and demented will be on the streets.

I guess this has to be a joke. Selection bias does strange things with the statistics of subgroups. It's perfectly possible immigrant doctors could have a mean IQ higher than the native doctors. And their variance could be higher or lower than non-doctors back home, higher or lower than native doctors, etc. Any configuration is possible.

USMLE is meritocratic.

Medicine is becoming more protocol-driven and micromanaged everywhere. It still needs fairly intelligent people to do the job, but almost nobody believes it will continue to inspire the most intelligent people to train for the job, if it ever did.

Primary care is becoming more stressful as the protocols and expectations build up, you need to know a little about everything, which is harder than knowing a lot about just one organ.

Someone mentioned the over credentialization of medicine, and I'll give you my experience as someone who's almost done with his year long paramedic training: Yep.

Not so much for paramedic, who's scope is all over the place and definitely needs to be a generalist since they do indeed see it all, but shit like Patient Care Tech and Respiratory Tech being expanded out to 4 year programs. Very limited scopes and knowledge needed and they are fleecing people.

Personally I think they need a paramedic with an expanded scope to operate in the field above and beyond what a normal medic does vs. Flight medic being the highest you're going as paramedic. Right now it's a catch as catch can with the various medic specialties (Flight/Wildnerness/Tactical/Austere) with scopes that are all over the place.

Medicine sucks now. Driving home from vacation my wife was on the phone for 2 hours to get an insurance comment to ok a prescription. They problem was the insurance company had just changed the forms, and her request was on the old form. It is the same form, but with a different number. They denied the request not because of medical reasons, but because of the form number. After two hours they agreed the form had all the correct info on it, and gave the ok.

She spends most of her time begging insurance companies or the medicaid overseer to agree with the treatment plan her patients require.

She fled her previous country because of this, and it is now worse in the usa. So we will probably bail out soon. As soon as I save enough to buy a small farm.

The current medical system is set up in such a way that doctors are discouraged from insisting on behavioral changes and are instead encouraged to prescribe, prescribe, prescribe.

I know a Nurse Practitioner that complains about this regularly. She says that the general physician that she works for complains to her when patients get mad regarding the Nurse's advice on lifestyle change, etc..

Patients often leave her office complaining that she won't prescribe meds when simple changes are required first and the physician in charge gripes about her running patients off. What a mess.

"Letting black women in with 2.5GPA and a 22 on their MCAT seemed criminal to me."

I had a Vietnamese woman OB when I was pregnant...imagine my horror when I'm about to give birth and a black lady walks in, gives the process two seconds before declaring I need an episiotomy and also ripping out my placenta which was horribly painful even though I had an epidural in. Pregnancy is another area where the Western European model should be used, though that really works best when both parents are of European descent, which is rarer every year in this country.

Most of the families I see WANT the prescription because it’s seen as being easier than the work of changing their behaviors

I wish there was a pill that had the effect of walking 10km. Non Asian minorities are bad enough at taking pills correctly, and you think we can just tell people an ALL YOU CAN EAT BUFFET is not supposed to be a challenge.

Oh, as an aside, doctors do NOT get kickbacks from pharmaceutical companies for prescribing medications

I know drug reps are not making it rain goodies like they did in the 90s, but they still have jobs.

related:CA Taxpayers overpay for assisted suicide drug. Its bad enough CA doctors are killing people on purpose but paying $5400, for a $3000 dose, but they don't have money for cancer treatments.

"So, by NOT allowing people on Medi-Cal cancer doctors, you assure their death—and by using the $5400 lethal dose, taxpayers save money. Is this unethical, immoral or just good business by government? This is the same government that spends tens of millions of dollars to keep murderers alive on death row. Confused?"

My brother is a primary care doctor. He just took a new job in a relatively prosperous area and the medical group he works for was absolutely thrilled to get an "American educated doctor" because 90% of the primary care doctors available for hire these days are third-worlders.

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